Provider Demographics
NPI:1851561567
Name:PHIPPS, KEITH (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 NW 25TH PL STE G
Mailing Address - Street 2:LE PAVILLION SHOPPING CENTER
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6569
Mailing Address - Country:US
Mailing Address - Phone:352-376-8229
Mailing Address - Fax:
Practice Address - Street 1:4401 NW 25TH PL STE G
Practice Address - Street 2:LE PAVILLION SHOPPING CENTER
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6569
Practice Address - Country:US
Practice Address - Phone:352-376-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 9951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist